New Beginnings Adult Mental Health Job Application

Job Application

All prospective employees will receive consideration without discrimination because of race, color, creed, age, natural origin, or handicap. All information proved herein will be kept confidential.
Full Name

First NameMiddle NameLast Name
Birth Date

MonthDayYear
Current Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email Address
example@example.com
Phone Number
LinkedIn
Position Applied
Available Start Date

MonthDayYear
Are you legally eligible for employment in the United States?

YesNo
Do you have experience working with individuals with mental illness?

YesNo
Do you have at least two years of experiencing working with individuals with mental illness or intellectual disabilities? Please note, this experience must be documented in your resume.

YesNo
Have you ever been convicted of a crime in the past 5 years, barring employment in a Home and Community Based program?

YesNo
Do you consent for New Beginnings Adult Mental Health to run a Criminal History Background check?

YesNo
Upload Your Resume*

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List 3 Professional References (Name and Phone numbers)
Upload Proof of Education

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Upload Credentials (Certified Peer Support, Licensed Chemical Dependency, Licensed Clinical Social Worker, Licensed Professional Counselor, LVN, Registered Nurse)

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Upload Photo ID*

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Upload Photo of SS Card*

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I certify that the facts contained in this application are true and complete to the best of my knowledge and understand, that if, employed, falsified statements on this application SHALL BE GROUNDS FOR DISMISSAL. I authorize complete investigation of all statements contained herein and herby give my full permission for the Agency to contact and fully discuss my background and history with all persons and entities listed above to give the Agency all information concerning my previous employment and any information that they may have, and release all former employees and others listed above from all liability for any damage that may result from furnishing the same to the Agency. I understand and agree that, if hired, my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time for any lawful reason, without prior notice and with or without cause. This application for employment shall be considered active for a period not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time shall inquire as to whether or not applications are being accepted at this time.

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Date

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Date
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